Evaluation of Multiple Sclerosis Patients' Disease Modifying Therapy Prior to and after Disease Relapse

Background: Multiple Sclerosis (MS) is a chronic progressive neuro-inflammatory and neuro-degenerative disease that affects nearly 1,000,000 people in the United States and over 2.5 million people worldwide. The standard practice to treat MS is through disease modifying therapy (DMT) drug regimens which delay disease relapse and progression. There are currently more than ten FDA approved DMTs available for the treatment of multiple sclerosis, all of which vary in efficacy and safety profiles. They also vary substantially in price, from $65,000 to $91,000 annually, as well as accessibility through insurer formularies. The efficacy, safety and availability in addition to patient specific factors such as laboratory data and disease severity, must be assessed when starting or changing disease modifying therapy.

Objectives: The primary objective of this project is to evaluate the change of DMT following a MS relapse event. The secondary outcome is to determine what patient characteristics predict a lateral versus an escalating approach to changes in DMT regimens.

Methods: This is a retrospective chart review of patients in the James Q. Miller Multiple Sclerosis Clinic practice who had a relapsing remitting MS diagnosis and were treated with intravenous steroids from 2014 to 2017. Patients were included if the steroid administration was for MS relapse, only. Patients were categorized if they were DMT naïve or being treated with a DMT at time of relapse. The current and/or new DMT regimen have been stratified into one of three groups categorized by efficacy (relapse-prevention). The groups will next be classified as a one-step change versus a two-step change in treatment regime (lateral vs. escalation). Then these groups will be compared by patient demographics and characteristics.  

Results: 70 patients have been identified. Analysis is in progress. Completed results will be available for the 05/2018 meeting.

Conclusions: Results will provide an understanding of which patients are more likely to receive an escalation in disease modifying therapy following a MS relapse.